Preventing Hospital Acquired Disability

Part of my further quest to improve the care of elderly patients -- this article is a must read. I particularly believe in the restriction of delerium inducing medications, the ambulate 3-4 times a day prescription (rather than AAT), and the wearing of clothes...

Those of you who have heard my "patients should wear pants unless they have a problem in the pants area" routing will appreciate where I am coming from.

Consult Service - October 18

1) Wow...  Triglycerides of 67mmol/L -- can't say I've seen that before -- and in a patient with mild pancreatitis.  Hence this article on the use of insulin infusion to treat severe hypertriglyceridemia and a review on options in pancreatitis caused by hypertriglyceridemia.  

Consult Service - October 17

We talked about a lot of things today.  Many have previously been blogged about -- I believe the search actually works now.

One topic we discussed, which I haven't touched on before was Warfarin Induced Skin Necrosis (this is a helpful review).

Causing harm through quality improvement...

Primum non nocere

This article discusses developing quality measures to offset the unintended harms that come with more aggressive attempts to reach quality benchmarks for therapy (i.e. hypertension).

Time Limited Trials

Decisions about end of life care is patients with significant comorbid illness is challenging.  This article is worth a read...  Time limited intervention plans. 

From the clinic Oct 5

Though we didn't all talk together about these issues -- here are a few topics related to our individual discussions.

1) Physical exam diagnosis of ascites (and related previous blog on ascites).

2) The famous histoplasmosis (prev blog) outbreak in Montreal in the 1960s during the digging of the subway tunnels .

3) Job's syndrome and Chronic Granulomatous Disease (also here)

4) Alcoholic liver disease (subtypes here).